Modifier 59 and 51

[KFLYNN70]

I am trying to figure when its appropriate to add modifier 51 or modifier 59.

Example- I have 2 codes, 25116 and 64721 and the DR would like to apply 59
I disagree, Can someone please advise

dx 354.0
dx 727.05
thanks

[mhstrauss]

Modifier 51 is appropriate in this case. Modifier 59 is generally used to bypass CCI edits when the services qualify. However, these 2 codes are not listed together in the edits, so no bundling issue. Claim should look like this:

25116 dx 727.05
64721-51 dx 354.0


Hope this helps!

[lblandin]

Codes 25116 and 64721 are bundled per CCI edits. In this case it would be appropriate to add a modifier 59 to 64721. Modifier 59, Distinct Procedural Service, is intended to be used to indicate that a procedure or service is distinct or independent from other services or procedures performed on the same day. This modifier is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances.

[mhstrauss]

Laura, would you mind posting where you found this info? I checked before I posted, and just rechecked again, and am not seeing what you are. Appreciate any input you can give, I am still fairly new at this.

Thanks!

[kandigrl79]

I agree with Laura. These two codes have a '1' indicator on the CCI edits which means they are billable under certain circumstances, but would require modifier 59.

[dadhich.girish]

I agree with Laura and kandigrl79 too.